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. 2016 Sep-Oct;82(5):500-6.
doi: 10.1016/j.bjorl.2015.08.021. Epub 2015 Dec 18.

Hearing function after betahistine therapy in patients with Ménière's disease

Seyed Javad Seyed Tootoonchi  1 , Samad Ghiasi  1 , Parvaneh Shadara  1 , Simin Mirakhor Samani  2 , Daniel Fadaei Fouladi  3
Affiliations

Hearing function after betahistine therapy in patients with Ménière's disease

Seyed Javad Seyed Tootoonchi et al. Braz J Otorhinolaryngol. 2016 Sep-Oct.

Abstract
in English, Portuguese

Introduction: Preventing or reversing hearing loss is challenging in Ménière's disease. Betahistine, as a histamine agonist, has been tried in controlling vertigo in patients with Ménière's disease, but its effectiveness on hearing problems is not known.

Objective: To examine the effect of betahistine on hearing function in not-previously-treated patients with Ménière's disease and to define possible contributors in this regard.

Methods: A total of 200 not-previously-treated patients with definite unilateral Ménière's disease received betahistine by mouth (initial dose, 16mg three times a day; maintenance dose, 24-48mg daily in divided doses). Changes in indicators of hearing status before and six months after treatment were documented. Hearing loss was considered as the mean hearing level >25dB HL at five frequencies.

Results: The mean duration of disease was 3.37 years. Six months after treatment the mean hearing level decreased by 6.35dB compared to that at the baseline (p<0.001). Both patients' age and the duration of disease correlated negatively with the improvement in hearing function. Post treatment hearing loss was independently associated with age, the initial hearing level and the chronicity of disease. The corresponding optimal cut-off points for predicating a persistent hearing loss 6 months after treatment were 47 years, 38dB HL, and 1.4 years, respectively.

Conclusion: Oral betahistine was significantly effective in preventing/reversing hearing deterioration in patients with Ménière's disease. Age, the hearing level on admission, and the disease duration were independent predictors of hearing status after treatment.

Introdução: Prevenir ou reverter a perda auditiva é um desafio na doença de Ménière. A beta-histina, um agonista de histamina, tem sido testada no controle de vertigem em pacientes com doença de Ménière, mas sua eficácia em problemas de audição ainda não é conhecida.

Objetivo: Analisar o efeito da beta-histina na função auditiva em pacientes com doença de Ménière não tratados previamente, e definir possíveis contribuintes a esse respeito.

Método: Um total de 200 pacientes sem tratamento prévio, e com diagnóstico definido de doença de Ménière unilateral, recebeu beta-histina por via oral (dose inicial de 16 mg três vezes ao dia; dose de manutenção de 24–48 mg por dia, em doses divididas). Alterações do limiar auditivo antes e após seis meses de tratamento foram documentadas. Considerou-se como perda auditiva uma média do nível de audição >25 dB NA em cinco frequências.

Resultados: A média de duração da doença foi de 3,37 anos. Seis meses após o tratamento, a média do limiar auditivo diminuiu em 6,35 dB, em comparação com o valor da linha de base (p < 0,001). Tanto a idade dos pacientes quanto a duração da doença apresentaram correlação negativa com a melhora da função auditiva. A perda auditiva após o tratamento foi independentemente associada à idade, ao nível inicial de audição e à cronicidade da doença. Os pontos de corte ótimos correspondentes para prever uma perda auditiva persistente seis meses após o tratamento foram 47 anos, 38 dB HL e 1,4 ano, respectivamente.

Conclusão: A beta-histina oral foi significantemente eficaz na prevenção/reversão da deterioração auditiva em pacientes com doença de Ménière. Idade, nível de audição na admissão e duração da doença foram fatores preditivos independentes da condição auditiva após o tratamento.

Keywords: Doença de Ménière; Hearing loss; Medical treatment; Ménière's disease; Perda de audição; Prognosis; Prognóstico; Tratamento médico.

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Figures

Figure 1
Figure 1
Changes in the mean hearing levels at baseline and six months after treatment. Error bars represent 95% confidence interval. *p ≤ 0.05 is statistically significant.
Figure 2
Figure 2
Simple scatterplots representing reverse correlations between patients’ age and improvement in the hearing level six months after treatment (IHL6) (A) and between disease duration and IHL6 (B).
Figure 3
Figure 3
Receiver operator characteristics’ curves of patients’ age and disease duration in predicting unfavorable hearing function six months after treatment. Area under the curve: 0.62 for age and 0.69 for disease duration (p = 0.01 and <0.001, respectively).
Figure 4
Figure 4
Receiver operator characteristics’ curves of patients’ age, baseline hearing level, and disease duration in predicting persistent hearing loss six months after treatment. Area under the curve: 0.66 for age, 0.76 for baseline hearing level, and 0.75 for disease duration (p = 0.01, <0.001, and <0.001, respectively).
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